Provider Demographics
NPI:1073842613
Name:GONZALEZ, ADIANNETTE (OD)
Entity Type:Individual
Prefix:DR
First Name:ADIANNETTE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 34600
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-9798
Mailing Address - Country:US
Mailing Address - Phone:787-930-2035
Mailing Address - Fax:
Practice Address - Street 1:HC 5 BOX 34600
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-9798
Practice Address - Country:US
Practice Address - Phone:787-930-2035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR670152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist